Healthcare Provider Details

I. General information

NPI: 1700942950
Provider Name (Legal Business Name): KENNETH L SCHOEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 FOREST AVE FOREST PROFESSIONAL ARTS BLDG
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

710 FOREST AVE FOREST PROFESSIONAL ARTS BLDG
STATEN ISLAND NY
10310
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-2065
  • Fax:
Mailing address:
  • Phone: 718-442-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number111572MD
License Number StateNY

VIII. Authorized Official

Name: DR. KENNETH L SCHOEN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-442-2065